Tobacco-induced contact dermatitis.

Tobacco and tobacco smoke are strongly associated with various skin conditions, among which contact dermatitis is of prime importance. The aetiological and clinical aspects vary according to the different tobacco production and processing steps. Contact dermatitis is frequent in tobacco harvesters, curers and cigar makers, whereas it rarely affects smokers and, only exceptionally, cigarette packaging workers. The skin sites involved also vary, according to whether the exposure is occupational or non-occupational. Tobacco contact irritation is far more frequent than contact allergy. The sensitizing compound in tobacco is unknown; nicotine, while highly toxic, does not seem to cause sensitization, except in rare cases. Besides natural substances, several compounds are added to tobacco during processing and manufacturing. For this reason, identifying the aetiological factors is exceedingly difficult. Another important aspect to take into account is the co-causative role of tobacco in eliciting or exacerbating contact dermatitis in response to other agents, occupational or extra-occupational.